Infectious Disease Compendium

Bell's palsy

Diagnosis

A seventh nerve palsy.

Epidemiologic Risks

See microbiology.

Microbiology

Herpes simplex and Lyme, the former is the cause of recurrent disease. Acute HIV can present with Bells (PubMed).

Empiric Therapy

Directed against the infecting organism; for Herpes, acyclovir or valacyclovir for 5 days (PubMed) PLUS prednisone 40-60 mg a day, preferably within 7 days of onset, is recommended to speed resolution, although data to support is suboptimal (PubMed).

More recently (2007) acyclovir added NOTHING to 25 mg bid prednisolone x 10 days given within 72 hours of onset (PubMed). The Cochrane review, and who in their right mind would argue with them?) agrees (PubMed).

Pearls

Lyme related Bell's usually has aseptic meningitis, painful neuropathy, more symptomatic systemically aka Bannworths syndrome.

Is associated, like many infections, with an increased risk of stroke (PubMed). What to do is unknown.

Rants

ICD9 Codes (Soon to be supplanted by ICD10)

Bell's palsy 351.0.